Developing a Rational Approach to Supplementation for Health & Performance

Introduction

• Supplements are not just food supplements; they can be efficacious for enhancing sleep, hormone function, and focus
• Supplements can be good or dangerous depending on dosage, sourcing, etc.
• The goal is to provide a rational guide to supplementation, taking into account various factors

Layers of Mental Health, Physical Health, and Performance

1. Behavioral tools: Actions we take and avoid (e.g., viewing morning sunlight, exercise, avoiding bright light exposure at night, avoiding caffeine late in the afternoon)
2. Nutrition: Macronutrients, storage of energy, vitamins, minerals, and micronutrients
3. Supplementation: Non-​​prescription compounds for various purposes, many of which are not available in food
4. Prescription drugs: Prescribed by a board-​​certified MD for specific health conditions

Developing a Rational Supplementation Protocol

• Consult a trusted board-​​certified physician before adding or subtracting any behavioral protocols, nutritional protocols, supplementation-​​based protocols, or prescription drug-​​based protocols
• Understand where you have needs that can be met by supplementation better than any other approach
• Learn how to think about supplementation and how it interacts with your nutrition and behaviors to maximize immediate and long-​​term health

Categories of Supplements

• Vitamins
• Minerals
• Adaptogens: Compounds that help the body adapt to stress and exert a normalizing effect upon bodily processes

Key Points

• Supplements are not just food supplements; they can be efficacious for enhancing sleep, hormone function, and focus
• Behavioral tools, nutrition, supplementation, and prescription drugs are all layers of mental health, physical health, and performance
• Consult a trusted board-​​certified physician before making any changes to your health regimen
• Understand where you have needs that can be met by supplementation better than any other approach

• Learn how to think about supplementation and how it interacts with your nutrition and behaviors to maximize immediate and long-​​term health
  Supplementation in a Larger Context

• Supplements cannot replace healthy behaviors

  • No pill can replace sunshine, exercise, social connection, sleep, or learning
  • Better living through chemistry still requires better living
• Ideal supplementation protocol depends on individual needs and goals

Foundational Supplements

• Designed to establish a foundation or provide insurance for nutritional intake 
  • Ensure a basic level of mental health, physical health, and optimal performance
• Appropriate to have multiple ingredients in foundational supplements 
  • Vitamins and minerals to compensate for deficiencies from diet or fasting
• Skeptics argue that supplements only produce expensive urine 
  • True for water-​​soluble vitamins (e.g., vitamin C) if ingested in high amounts
  • Many people may not get enough water-​​soluble vitamins from their diet
  • Ingesting higher-​​than-​​needed amounts can be safe if not exceedingly high
• Fat-​​soluble vitamins can be stored in the body, potentially causing issues if taken in excess 
  • Unlikely to be a problem if vitamin-​​mineral supplements are not taken in excess

Deciding to Take Vitamin-​​Mineral Supplements

• Consider the cost and whether it’s within your budget 
  • Prices can range from pennies per day to tens of dollars per day
  • Variations in quality and sourcing can affect the price
• Assess your current diet and nutritional intake 
  • Different diets (vegan, vegetarian, omnivore, carnivore) provide varying levels of vitamins and minerals
  • Frequency and quantity of food consumption also play a role

• Consult with a healthcare professional to determine if supplementation is necessary for your specific needs
  Quality and Cost of Vitamin Mineral Supplements

• No significant differences in quality between water-​​soluble and fat-​​soluble vitamins in cheaper vs. more expensive supplements

• Cost typically scales with dosages and sourcing of vitamins and minerals
• Consider financial affordability and ability to obtain vitamins and minerals from food sources

Factors to Consider for Vitamin Mineral Supplements

• Suitable for highly physically or mentally active individuals or those following intermittent fasting
• Important to ingest with food, ideally early in the day
• Avoid exceedingly high dosages to prevent buildup of fat-​​soluble vitamins and over-​​reliance on supplements for nutrition

Importance of Non-​​Processed and Minimally Processed Foods

• Aim for 75%-80% of food intake from non-​​processed or minimally processed sources
• Avoid highly processed foods with long ingredient lists and shelf lives
• Focus on fruits, vegetables, meats, eggs, rice, oatmeals, pastas, and beans

Foundational Supplements

• Expanded to include vitamins, minerals, digestive enzymes, adaptogens, probiotics, and prebiotics
• Digestive enzymes found in foods like papaya and pineapple
• Adaptogens, such as ashwagandha, improve the body and brain’s ability to buffer against stressors
• Probiotics and prebiotics support the gut microbiome

Supporting the Gut Microbiome

• Consume low-​​sugar fermented foods (e.g., sauerkraut, kimchi, Greek yogurt, kombucha, kefir, natto)
• Aim for four servings a day to improve gut microbiome function, immune system, and reduce inflammation
• Fiber intake can also support gut microbiome, but effects vary among individuals

• Foundational supplements often include prebiotics and probiotics to support gut microbiota and gut-​​brain axis
  Importance of Gut Microbiome Support

• Most people lack gut microbiome support from their diet

  • Low sugar fermented foods and prebiotic fiber are essential
• Prebiotic and probiotic capsules can be expensive and require refrigeration 
  • Pickles, sauerkraut, and other fermented foods must be refrigerated to support gut microbiome

Foundational Supplements

• Support the gut microbiome through prebiotics and probiotics 
  • Be cautious of excessive amounts, which can lead to brain fog and other issues
• Adaptogens: micronutrients, herbs, and non-​​psychedelic mushrooms that buffer stress and enhance cognitive function 
  • Hard to obtain sufficient concentrations from food sources
• Foundational supplements should include vitamins, minerals, probiotics, prebiotics, digestive enzymes, and adaptogens 
  • Athletic Greens is one example of a comprehensive foundational supplement

Determining the Right Supplement

• Ask three questions: 
  1. How well are you sleeping at night?
  2. How is your nutrition?
  3. What is your budget for supplements?
• If budget is $100 or more per month, focus on foundational supplements like Athletic Greens or similar products
• If budget is lower than $100 per month, explore other options for foundational supplementation

Single Ingredient Formulation Supplements

• Designed to achieve specific endpoints
• Can be used in combination with foundational supplements to target specific needs 

Sleep

• Sleep is the foundation of mental health, physical health, and performance
• Struggling with sleep can lead to mood, cognitive clarity, and performance issues
• Consider nutrition and behavioral tools: 
  • Limit or eliminate caffeine after 2:00 p.m.
  • Avoid food within 2 hours prior to bedtime
• Supplements to support sleep: 
  • Myoinositol (900 mg) — helps shorten the time to fall back asleep if waking up in the middle of the night
  • L‑theanine (100–400 mg) — helps with falling asleep, but may cause excessively vivid dreams for some people
  • Magnesium Threonate or Magnesium Bisglycinate — helps with falling asleep faster and deeper sleep
  • Apigenin — derivative of Chamomile, helps with anxiety and falling asleep
• Systematically try supplements for falling asleep vs. remaining asleep 
  • Try single ingredient formulations for about a week without changing other factors
  • Evaluate which supplement works best for you

Cognitive Enhancement and Focus

• Not discussed in the provided transcript
  Supplementation for Sleep

• Importance of isolating variables in supplementation

  • Helps find what works best for the individual
  • Keeps costs limited
  • Identifies what works poorly and what works well

• Melatonin

  • Hormone that induces sleepiness, but not maintaining sleep
  • Supplements often contain excessive amounts compared to natural levels
  • Can impact other hormone systems, such as reproductive hormones
  • Useful for jet lag and occasional use, but caution advised
  • Inconsistent dosages in supplements, even from reputable brands

• Dependency on sleep supplements

  • No problem falling and staying asleep without supplements
  • Depth and duration of sleep may be better with supplementation
  • Not the same dependence as with sleeping pills
  • Placebo effects and belief effects can play a role
  • Experiment with taking breaks from supplements to assess dependency

Hormone Support

• Optimizing hormones is crucial for mental health, physical health, and performance
• Hormone health can be improved through non-​​prescription supplements
• Adequate calories from high-​​quality sources are essential for hormone health 
  • Insufficient calories can lead to issues with testosterone and estrogen levels

Behavioral Tools and Nutrition for Hormone Health

• Ensuring proper calorie intake and high-​​quality sources of nutrition
• Regular exercise and stress management
• Adequate sleep and proper supplementation

Supplementation for Cognitive Enhancement and Focus

• Stimulant and non-​​stimulant supplements can enhance cognitive ability and focus
• No dependency established by taking supplements for cognitive enhancement
• Placebo effects and belief effects can play a role in perceived dependency

Sex hormone binding globulin (SHBG) binds to testosterone and other hormones, preventing them from being in their active form

Nutrition and Behaviors for Hormone Support

• Nutrition and behaviors should be optimized before considering supplementation or prescription approaches
• Morning sunlight exposure can increase cortisol levels for focus, alertness, and immune function
• Strenuous exercise, including cardiovascular and resistance training, can alter hormone profiles

Broadband Support for Multiple Hormones

• Shilajit (contains fulvic acid) can increase FSH, libido, and indirectly increase testosterone
• Ashwagandha can reduce cortisol levels and indirectly increase testosterone 
  • Should not be taken for more than two weeks at high dosages
• L‑carnitine can improve sperm motility, egg quality, and impact mitochondrial pathways

Supplements for Specific Hormone Pathways

• Maca root can increase libido, particularly in women and those taking SSRIs 
  • Works through dopamine-​​related pathways and upstream hormone pathways
• Supplements for growth hormone: 
  • Quality deep sleep and avoiding food intake 2 hours before sleep can boost growth hormone
  • Arginine supplementation has weak evidence for increasing growth hormone
  • Prescription compounds like Cermarellin and growth hormone can significantly increase growth hormone levels

• Supplements for testosterone and luteinizing hormone (LH):

  • LH is released from the pituitary gland and stimulates estrogen and testosterone production
  • Supplements that increase GnRH and/​​or LH can indirectly increase testosterone and estrogen
  • Both testosterone and estrogen are important for libido, muscle growth, and overall health in males and females
    Supplements for Hormone Augmentation

• Phdogia agrestus

  • Herb that can impact luteinizing hormone pathway and GnRH
  • Dosages of 600mg per day can elevate libido, sperm production, testosterone, and estrogen
  • Can be toxic at high dosages, so follow recommended dosage and cycle usage (e.g., 8 weeks on, 2 weeks off or 12 weeks on, 1 month off)
  • Blood tests are essential to evaluate the impact of supplements on hormones
• Tongkat Ali
  • Can increase libido and free testosterone by reducing sex hormone-​​binding globulin
  • Beneficial for both men and women in dosages from 200mg to 600mg per day
  • Effects may take longer to experience (8–12 weeks)
  • Likely impacts neural pathways as well as hormone pathways
  • Does not need to be cycled like Phdogia agrestus

Considerations for Hormone Supplementation

• Start with the minimum effective dose and build up your protocols over time
• Isolate variables by taking one supplement at a time and evaluating its effects
• Blood tests are crucial for determining the effectiveness and safety of supplements
• Floor effects and ceiling effects: individuals with lower hormone levels may experience greater effects from supplements, while those with higher levels may not see much change

Female Hormone Health and Supplementation

• Women should expect that certain supplements may have different effects at different phases of the menstrual cycle due to varying hormone levels
• Upcoming episode on female hormones and hormone health will cover this topic in more detail “Human3 Attia Style” Notes:

Supplement Regimen and Menstrual Cycle

• Importance of dosage and ingredient control in supplements 
  • Example: Shilaji, Tonga Ali, Maka — benefits vary across menstrual cycle phases
  • Adjusting dosage or stopping intake during certain phases
• Hormone-​​based birth control can impact hormone fluctuations 
  • May affect how supplements interact with the body

Fertility and Supplements

• Supplements can improve sperm and egg health (e.g., L‑carnitine)
  • Injectable L‑carnitine requires prescription in the US
• Consider interactions between fertility supplements and hormone-​​based medications 
  • Relevant for couples trying to conceive, undergoing IVF, etc.
• Upcoming podcast episodes on fertility and female hormone health

Cognitive Enhancement and Focus Supplements

• Two categories:
  1. Stimulant-​​based supplements (e.g., caffeine)
  2. Non-​​stimulant-​​based supplements (e.g., Alpha GPC)

Stimulant-​​Based Supplements

• Caffeine: increases alertness and focus 
  • Effective even with regular use
  • Avoid intake past 2 PM to prevent sleep disruption
• Sleep: best cognitive enhancer 
  • Sufficient sleep duration crucial for focus and memory consolidation
• Nutrition: balance hunger and calorie intake for optimal focus
• Caffeine sources: coffee, tea, energy drinks, pure supplements (tablets/​​capsules)
  • Pure caffeine supplements have more potent and long-​​lasting effects
  • Caution for those with anxiety or panic attacks
• Other stimulants: yohimbine, alpha yohimbine (Rauwolscine)
  • Marketed for libido and erectile function, but low efficacy
  • Effective as stimulants for alertness, fat loss, and focus
  • Can cause anxiety in some individuals

Non-​​Stimulant-​​Based Supplements

• Alpha GPC: choline donor, enhances focus through acetylcholine pathways
  Alpha GPC and L‑Tyrosine for Focus

• Alpha GPC dosages: 300–600mg

  • Half-​​life: 4–6 hours
  • Enhances focus by augmenting acetylcholine pathways
  • Increases alertness but not a stimulant like caffeine
• L‑Tyrosine dosages: 500–1000mg
  • Amino acid precursor to dopamine
  • Enhances focus without stimulant-​​based alertness
• Combining Alpha GPC and L‑Tyrosine
  • Can be taken together if tried separately and found effective
  • Cholinergic stimulation from Alpha GPC and dopaminergic stimulation from L‑Tyrosine increase focus without overstimulation

Omega‑3 Fatty Acids for Brain and Body Health

• Benefits of omega‑3 fatty acids: 
  • Offset depression and improve mood
  • Reduce the need for antidepressant medication
  • Improve metabolic function and cardiovascular health
  • Enhance focus and cognitive ability
• Ingesting 1–3 grams of EPA (eicosapentaenoic acid) daily 
  • Can be found in fish oil capsules or liquid
  • Beneficial for brain and body health
  • Mothers who supplement with omega-​​3s have healthier offspring with greater brain weights

Food-​​Based or Food Mimic Supplements

• Examples: whey proteins, milk proteins, egg proteins, plant proteins, branched-​​chain amino acids, green tea supplements
• Can serve as meal replacements and provide convenience
• Whole foods are still important for fiber, satiety, and additional nutrients not found in supplements

Age-​​Related Effects and Supplements for Kids

• Omega‑3 fatty acids can be beneficial for developing children

  • Can be obtained from food sources or supplemented
  • Some parents choose to supplement on top of a healthy diet for optimal development
    Melatonin and Children

• Melatonin is already chronically elevated in kids

• Growing body of literature suggests potential harm in melatonin supplementation for children
• Approach melatonin with caution, especially for kids

Supplements for Different Age Groups

• Hormone augmentation and support supplements should be avoided for children unless recommended by a board-​​certified MD
• Be cautious about augmenting hormones in young people through supplementation
• For ages 22–24 and older, no significant differences in protocols between age groups
• Cognitive enhancement may be more beneficial for older individuals due to age-​​related cognitive decline

Importance of Behaviors and Nutrition

• Behaviors such as exercise, sleep, light exposure, and social connection are crucial for overall health
• Nutritional tools and behavioral tools serve as the primary foundation for supplementation protocols
• Supplementation may not be necessary for everyone, but can be beneficial for those looking to enhance sleep, focus, and hormone function

Developing a Rational Supplementation Protocol

• Focus on single ingredient formulations for sleep, hormone health, and cognitive function
• Foundational supplements (vitamins, minerals, digestive enzymes, probiotics, prebiotics, and adaptogens) can be combined
• Single ingredient formulations give more control and allow for finding minimal effective doses
• Aim to create a manageable and effective supplementation regimen without excessive spending

Supplements as Potent Compounds

• Supplements can be powerful tools for mental and physical health and performance
• They are just one element within an ecosystem of factors, including behaviors, nutrition, and prescription drugs
• Customize tools for individual mental and physical health and performance